[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5686 Introduced in House (IH)]








109th CONGRESS
  2d Session
                                H. R. 5686

   To amend title XIX of the Social Security Act to provide medical 
 assistance for certain men screened and found to have prostate cancer 
              under a federally funded screening program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 26, 2006

  Ms. Norton introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend title XIX of the Social Security Act to provide medical 
 assistance for certain men screened and found to have prostate cancer 
              under a federally funded screening program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicaid Prostate Cancer Coverage 
Act of 2006''.

SEC. 2. OPTIONAL MEDICAID COVERAGE OF CERTAIN PROSTATE CANCER PATIENTS.

    (a) Coverage as Optional Categorically Needy Group.--
            (1) In general.--Section 1902(a)(10)(A)(ii) of the Social 
        Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
                    (A) in subclause (XVIII), by striking ``or'' at the 
                end;
                    (B) in subclause (XIX), by adding ``or'' at the 
                end; and
                    (C) by adding at the end the following:
                                    ``(XX) who are described in 
                                subsection (dd) (relating to certain 
                                prostate cancer patients);''.
            (2) Group described.--Section 1902 of such Act (42 U.S.C. 
        1396a) is amended by adding at the end the following:
    ``(dd) Individuals described in this paragraph are individuals 
who--
            ``(1) are not described in subsection (a)(10)(A)(i);
            ``(2) have not attained age 65;
            ``(3) have been screened for prostate cancer under section 
        317D of the Public Health Service Act (42 U.S.C. 247b-5), or 
        any other prostate cancer screening program supported with 
        Federal funds, and need treatment for prostate cancer;
            ``(4) are in families whose income does not exceed 250 
        percent of the income official poverty line (as defined by the 
        Office of Management and Budget, and revised annually in 
        accordance with section 673(2) of the Omnibus Budget 
        Reconciliation Act of 1981) applicable to a family of the size 
        involved; and
            ``(5) are not otherwise covered under creditable coverage, 
        as defined in section 2701(c) of the Public Health Service Act 
        (45 U.S.C. 300gg(c)).''.
            (3) Limitation on benefits.--Section 1902(a)(10) of such 
        Act (42 U.S.C. 1396a(a)(10)) is amended in the matter following 
        subparagraph (G)--
                    (A) by striking ``and (XIV)'' and inserting 
                ``(XIV)''; and
                    (B) by inserting ``, and (XV) the medical 
                assistance made available to an individual described in 
                subsection (aa) who is eligible for medical assistance 
                only because of subparagraph (A)(10)(ii)(XX) shall be 
                limited to medical assistance provided during the 
                period in which such an individual requires treatment 
                for prostate cancer'' before the semicolon.
            (4) Conforming amendments.--Section 1905(a) of the Social 
        Security Act (42 U.S.C. 1396d(a)) is amended in the matter 
        preceding paragraph (1)--
                    (A) in clause (xii), by striking ``or'' at the end;
                    (B) in clause (xiii), by adding ``or'' at the end; 
                and
                    (C) by inserting after clause (xiii) the following:
            ``(xiv) individuals described in section 1902(dd),''.
    (b) Presumptive Eligibility.--
            (1) In general.--Title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) is amended by inserting after section 
        1920B the following:

     ``presumptive eligibility for certain prostate cancer patients

    ``Sec. 1920C.  (a) State Option.--A State plan approved under 
section 1902 may provide for making medical assistance available to an 
individual described in section 1902(dd) (relating to certain prostate 
cancer patients) during a presumptive eligibility period.
    ``(b) Definitions.--For purposes of this section:
            ``(1) Presumptive eligibility period.--The term 
        `presumptive eligibility period' means, with respect to an 
        individual described in subsection (a), the period that--
                    ``(A) begins with the date on which a qualified 
                entity determines, on the basis of preliminary 
                information, that the individual is described in 
                section 1902(dd); and
                    ``(B) ends with (and includes) the earlier of--
                            ``(i) the day on which a determination is 
                        made with respect to the eligibility of such 
                        individual for services under the State plan; 
                        or
                            ``(ii) in the case of such an individual 
                        who does not file an application by the last 
                        day of the month following the month during 
                        which the entity makes the determination 
                        referred to in subparagraph (A), such last day.
            ``(2) Qualified entity.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                term `qualified entity' means any entity that--
                            ``(i) is eligible for payments under a 
                        State plan approved under this title; and
                            ``(ii) is determined by the State agency to 
                        be capable of making determinations of the type 
                        described in paragraph (1)(A).
                    ``(B) Regulations.--The Secretary may issue 
                regulations further limiting those entities that may 
                become qualified entities in order to prevent fraud and 
                abuse and for other reasons.
                    ``(C) Rule of construction.--Nothing in this 
                paragraph shall be construed as preventing a State from 
                limiting the classes of entities that may become 
                qualified entities, consistent with any limitations 
                imposed under subparagraph (B).
    ``(c) Administration.--
            ``(1) In general.--The State agency shall provide qualified 
        entities with--
                    ``(A) such forms as are necessary for an 
                application to be made by an individual described in 
                subsection (a) for medical assistance under the State 
                plan; and
                    ``(B) information on how to assist such individuals 
                in completing and filing such forms.
            ``(2) Notification requirements.--A qualified entity that 
        determines under subsection (b)(1)(A) that an individual 
        described in subsection (a) is presumptively eligible for 
        medical assistance under a State plan shall--
                    ``(A) notify the State agency of the determination 
                within 5 working days after the date on which 
                determination is made; and
                    ``(B) inform such individual at the time the 
                determination is made that an application for medical 
                assistance under the State plan is required to be made 
                by not later than the last day of the month following 
                the month during which the determination is made.
            ``(3) Application for medical assistance.--In the case of 
        an individual described in subsection (a) who is determined by 
        a qualified entity to be presumptively eligible for medical 
        assistance under a State plan, the individual shall apply for 
        medical assistance under such plan by not later than the last 
        day of the month following the month during which the 
        determination is made.
    ``(d) Payment.--Notwithstanding any other provision of this title, 
medical assistance that--
            ``(1) is furnished to an individual described in subsection 
        (a)--
                    ``(A) during a presumptive eligibility period;
                    ``(B) by a entity that is eligible for payments 
                under the State plan; and
            ``(2) is included in the care and services covered by the 
        State plan;
shall be treated as medical assistance provided by such plan for 
purposes of section 1903(a)(5)(B).''.
            (2) Conforming amendments.--
                    (A) Section 1902(a)(47) of the Social Security Act 
                (42 U.S.C. 1396a(a)(47)) is amended--
                            (i) by striking ``and provide'' and 
                        inserting ``, provide''; and
                            (ii) by inserting before the semicolon at 
                        the end the following: ``, and provide for 
                        making medical assistance available to 
                        individuals described in subsection (a) of 
                        section 1920C during a presumptive eligibility 
                        period in accordance with such section''.
                    (B) Section 1903(u)(1)(D)(v) of such Act (42 U.S.C. 
                1396b(u)(1)(D)(v)) is amended--
                            (i) by striking ``or for'' and inserting 
                        ``, for''; and
                            (ii) by inserting before the period the 
                        following: ``, or for medical assistance 
                        provided to an individual described in 
                        subsection (a) of section 1920C during a 
                        presumptive eligibility period under such 
                        section''.
    (c) Enhanced Match.--Section 1903(a)(5) of the Social Security Act 
(42 U.S.C. 1396b(a)(5)) is amended--
            (1) by striking ``an'' and inserting ``(A) an'';
            (2) by adding ``plus'' after the semicolon; and
            (3) by adding at the end the following:
            ``(B) an amount equal to 75 percent of the sums expended 
        during such quarter which are attributable to the offering, 
        arranging, and furnishing (directly or on a contract basis) of 
        prostate cancer-related treatment services; plus''.
    (d) Effective Date.--The amendments made by this section apply to 
medical assistance furnished on or after the date of the enactment of 
this Act, without regard to whether final regulations to carry out such 
amendments have been promulgated by such date.
                                 <all>